Comment on: “Intratympanic Lidocaine as a Potent Remedy for Tinnitus in Sudden Sensorineural Hearing Loss: A Double-Blind, Randomized Clinical Trial”

Dear Editor We read with great interest the study by Di Zhang et al. (1) in a recent issue of Otology & Neurotology where they suggest that intratympanic lidocaine provides a safe, efficacious treatment option for SSNHL tinnitus. Lidocaine as a medication for relieving tinnitus has been widely accepted for its therapeutic effect. However, we have some other ideas here that we would like to share. Firstly, the authors chose saline as a blank control, which is suitable as a placebo due to its nontoxic side effects. However, the intratympanic injection is invasive, and there is currently no basis to recommend saline as a kind of injection fluid. We believe that the treatment of the control group may increase unnecessary side effects and sequelae, causing harm to patients, and we have doubts about the rationality of this method. Secondly, although intravenous lidocaine can cause systemic side effects, its therapeutic effect on tinnitus is certain and recommended by guidelines (2).As there is no conclusive evidence in the article to prove that intratympanic injection of lidocaine has a better therapeutic effect on tinnitus than intravenous administration, further research is suggested to confirm the benefits of intraauricular injection. If there is no difference in the therapeutic effect of tinnitus, we suggest weighing the pros and cons and choosing the appropriate medication method. Last but not least, intratympanic injection, as an invasive procedure, may increase patients' pain and fear compared with intravenous administration, and also increase the risk of otitis media and damage to the middle ear and inner ear, especially for patients with eustachian tube dysfunction, who are more prone to ear discomfort. For family doctors and junior otolaryngologists, it also increases the difficulty of operation. As a minimally invasive local administration method, retroaural injection may reduce the occurrence of complications. Yali Liu, MDENT DepartmentXiangyang No.1 People's HospitalHubei University of MedicineXiangyang, Hubei, ChinaGuowei Ma, PhDSchool of PharmacyDepartment of PharmacologyChina Medical UniversityShenyang, Liaoning, ChinaYuanyuan Wu, MDENT DepartmentXiangyang No.1 People's HospitalHubei University of MedicineXiangyang, No.15 Jiefang StreetFancheng, XiangyangHubei 441000, China [email protected]